Hydroxyzine for anxiety: how effective is it?

Hydroxyzine is a prescription-only drug that is one of several medications that can help with anxiety. The medication is generally safe and effective at relieving anxiety symptoms, though not without several mild and even a few potential severe side effects. The Food & Drug Administration (FDA) has approved it for the treatment of general anxiety disorder, or GAD.

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Hydroxyzine is an antihistamine, so it blocks the effects of histamines, which are part of the body’s immune system. You probably know antihistamines as drugs which treat hay fever and other allergies.

It’s not known exactly how it works for anxiety, but when prescribed in adults or children, hydroxyzine decreases activity in the brain, having a calming effect. It’s also used as a sedative before and after anesthesia, and it can treat some allergic skin reactions (National Center for Biotechnology Information, 2021). The Food & Drug Administration has determined hydroxyzine to be useful and safe when used as directed (Garakani, 2020).

In a study of 334 people diagnosed with general anxiety disorder, hydroxyzine worked better than a placebo, serving as an effective alternative to bromazepam—a medication that’s part of a class of drugs (benzodiazepines or “benzos”) often prescribed for GAD (Llorca 2002). A subsequent study again found hydroxyzine better than a placebo, and the results suggested it “may be similar in efficacy to both benzodiazepine and buspirone, another anti-anxiety medication (Rudolph, 2020). 

There are advantages and disadvantages with hydroxyzine compared to other anti-anxiety medications. Unlike lorazepam (brand name Ativan) and other benzodiazepines like alprazolam (brand name “Xanax”), hydroxyzine is not considered addictive (National Alliance on Mental Illness, 2016). But over time, people tend to develop tolerance to antihistamines like hydroxyzine, rendering them less effective (Garakani, 2020).

Hydroxyzine is sold under several brand names (Vistaril, Orgatrax, Atarax)  and is also available as a generic. It is taken orally as a liquid, capsule, or tablet. You can take it daily or as needed, but the dose and timing should all be worked out by your healthcare provider.

The dose depends on someone’s diagnosis and may change over time, but a typical dosage for an adult with anxiety might be anywhere between 25 to 100 milligrams, up to four times daily. Children are prescribed much less (Mayo Clinic, 2021).

Hydroxyzine can have serious side effects that require immediate medical attention, including seizures, trembling or shaking, rashes, or pus-filled blisters. Less serious side effects include dry mouth, constipation, confusion, drowsiness, and dizziness or headaches. The drug can interact negatively with a range of other medications. Pregnant or breastfeeding women should not take hydroxyzine (FDA, 2014). 

Before prescribing any medication, a healthcare provider will want to know if your anxiety rises to the level of a clinical diagnosis.

It’s normal for any human to experience anxiety now and then, as we worry about the challenges of life and the many stressors that are thrown at us. 

However, if anxiety becomes extreme or constant, causing excessive worry on a daily basis even as you sense that the worries are overblown, you might have general anxiety disorder or GAD. General anxiety disorder is marked by the following symptoms (National Institute of Mental Health, 2016):

• Difficulty relaxing or concentration

• Trembling or twitching

• Sleep problems

• Irritability

Anxiety is quite common. In the United States, anxiety disorders affect about one in five of adults per year, while 31% are diagnosed with an anxiety disorder at some point in life (National Institute of Mental Health, 2017). 

If you are diagnosed with an anxiety disorder, a psychiatrist or other healthcare provider will typically prescribe medications and/or cognitive behavioral therapy, both of which have been shown to improve quality of life for people with GAD (Bandelow, 2017).

If you’re just experiencing anxiety now and then, and you think it’s manageable, there are several potential remedies. Breathing exercises—super easy to do—are known to reduce anxiety (Harvard Health Publishing, 2020). 

More generally, your lifestyle can have a strong effect: Staying physically active and eating and sleeping well are all linked to lower anxiety levels (National Institute of Mental Health, 2016). 

If you’re feeling a little anxious right now, stop and take a deep breath. Literally. That just might be a great first step to relieve your anxiety. If that doesn’t help—or if you feel like nothing will—it’s time to see a healthcare provider to find out what’s behind your stress and angst and what can be done about it. 

Armed with all this information, you’re ready to ask a physician or psychiatrist if hydroxyzine would be an appropriate part of any treatment you’re prescribed.

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Current version

May 13, 2021

Written by

Robert Roy Britt

Fact checked by

Felix Gussone, MD

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About the medical reviewer

Felix Gussone, MD, Ro

Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.